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Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

Note that this analysis of a large cancer database found that, for early-stage non-small cell lung cancer, surgery still offered the best chance of survival, but radiation therapy is making rapid gains.

These improvements seem to be driven by broader adoption of stereotactic body radiotherapy.

BOSTON -- Surgery continued to offer the best survival for older patients with early lung cancer, but radiation therapy substantially closed the gap, a longitudinal review of national data showed.

As of 2012, patients 60 or older had a 23-month overall survival (OS) of 84% with surgery for stage I non-small cell lung cancer (NSCLC). Radiation led to a 23-month survival of 58%.

However, 23-month survival with primary radiation therapy demonstrated an absolute improvement of 19% from 2004 to 2012, as compared with 5% for surgery. Radiation also closed the gap between surgery with respect to cause-specific survival. The survival gains occurred against a backdrop of widespread adoption of stereotactic body radiotherapy as the community standard for older patients with early NSCLC.

Alluding to the observation that more than 10% of the patients in the study received no treatment, Farach added, "SBRT may improve access to care."

Press briefing moderator Brian Kavanagh, MD, said the improved survival observed in the study reflected the impact of widespread adoption of SBRT to treat NSCLC. The improved outcomes might extend to even more patients if many of the untreated patients received the therapy.

"SBRT has improved outcomes. Lung cancer patients are living longer with this mode of treatment, relative to the length of time with older forms of treatment," said Kavanagh, of the University of Colorado in Denver. "It would be tragic if we were unable to give this treatment to a lot of patients who need it."

Farach and Kavanagh both said that SBRT offers the potential to decrease the proportion of older patients who receive no treatment for early NSCLC. They said SBRT is generally well tolerated, even in older patients and those with comorbid conditions.

Reviewing the background for the study, Farach noted that NSCLC is a disease of older people. Two-thirds of new diagnoses involve patients who are 65 or older. Another 21.5% of new diagnoses involve the age group 55 to 64.

Historically, surgery has been the primary option for patients with newly diagnosed, resectable tumors. The introduction and adoption of SBRT has added a new consideration to decision making, especially for patients with early NSCLC. In 2004, fewer than 5% of all patients with newly diagnosed NSCLC (irrespective of stage) received SBRT as part of their care. By 2011, the percentage approached 10%.

To provide contemporary data on outcomes for older patients with stage I NSCLC, Farach and colleagues queried the NCI Surveillance, Epidemiology, and End Results database to identify patients 60 or older treated for stage I NSCLC from 2004 to 2012. The search yielded 62,213 patients for data analysis.

The data showed that 41,509 patients had surgery alone, 11,589 patients had radiotherapy alone, and 1,742 received both surgery and radiation therapy. The remaining 7,373 (11.9%) received no cancer-specific treatment.

Investigators examined use of different treatment strategies across seven age groups, ranging from 60 to 64 to ≥90. Surgery predominated for all but the two oldest age groups, representing the sole treatment for 81% of patients 60 to 64, decreasing to about 50% of patients ages 80 to 84 and 21% of patients 90 or older.

Use of radiation therapy as primary treatment increased with patient age. Farach reported that 11% of patients 60 to 64 had primary radiation therapy, increasing to 40% of patients 90 or older, and a similar proportion of patients in the 85-to-89 age group.

The proportion of patients who received no cancer-specific treatment also increased with age. All but 7% of patients 60 to 64 received surgery, radiation therapy, or both. The percentage increased gradually but steadily until age 80, when the proportion of untreated patients jumped to about 20%, increasing to 25% of patients 85 to 89, and almost 40% of those 90 or older.

The 23-month OS and cause-specific survival (CSS) improved over the time period of the studies, regardless of the type of therapy, including patients who received no treatment. Surgically-treated patients had the best OS in 2004 (79%) and at the end of 2011 (84%, P<0.05). Survival following radiation therapy improved the most during the study period, increasing from 39% in 2004 to 58% in 2011 (P<0.05). Among patients who received no cancer-directed therapy, 23-month survival improved from 28% in 2004 to 33% in 2011 (P=0.29).

The 23-month CSS improved from 87% to 91% among surgically treated patients (P<0.05). The biggest improvement occurred in the radiation therapy subgroup, which had a 23-month CSS of 48% in 2004, increasing to 72% by the end of 2011 (P<0.05). Older patients with untreated stage I NSCLC had a 23-month CSS of 38% in 2004, increasing to 45% in 2011 (P=0.06).

Farach and co-authors disclosed no relevant relationships with industry.

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